Patient dissatisfaction after total joint arthroplasty can be as high as 20%. There are many factors that lead to dissatisfaction including unmet expectations, persistent pain, and technical errors. There is increasing evidence that psychological factors play a role in a patient's ability to manage with the surgical stress of total joint arthroplasty. These factors play an important role in dissatisfaction after surgery. In addition, there are several studies that demonstrate certain psychological factors such as resiliency can affect patient outcomes. This symposium explores the impact of these psychological factors on total joint arthroplasty with a specific focus on identification and modification of these factors.